Risk factors for second primary neoplasia of esophagus in newly diagnosed head and neck cancer patients: a case–control study

Abstract

BackgroundThe prevalence of esophageal neoplasia in head and neck (H&N) cancer patients is not low; however, routine esophageal surveillance is not included in staging of newly-diagnosed H&N cancers. We aimed to investigate the risk factors for synchronous esophageal neoplasia and the impact of endoscopy on management of H&N cancer patients.MethodsA total of 129 newly diagnosed H&N cancer patients who underwent endoscopy with white-light imaging, narrow-band imaging (NBI) with magnifying endoscopy (ME), and chromoendoscopy with 1.5% Lugol’s solution, before definite treatment were enrolled prospectively.Results60 esophageal lesions were biopsied from 53 (41.1%) patients, including 11 low-grade, 14 high-grade intraepithelial neoplasia and 12 invasive carcinoma in 30 (23.3%) patients. Alcohol consumption [odds ratio (OR) 5.90, 95% confidence interval (CI) 1.23-26.44], advanced stage (stage III and IV) of index H&N cancers (OR 2.98, 95% CI 1.11-7.99), and lower body mass index (BMI) (every 1-kg/m2 increment with OR 0.87, 95% CI 0.76-0.99) were independent risk factors for synchronous esophageal neoplasia. NBI with ME was the ideal screening tool (sensitivity, specificity, and accuracy of 97.3%, 94.1%, and 96.3%, respectively, for detection of dysplastic and cancerous esophageal lesions). The treatment strategy was modified after endoscopy in 20 (15.5%) patients. The number needed to screen was 6.45 (95% CI 4.60-10.90).ConclusionsNBI-ME surveillance of esophagus should be done in newly-diagnosed H&N cancer patients, especially those with alcohol drinking, lower BMI, and advanced stage of primary tumor.

Narrow band imaging versus lugol chromoendoscopy to diagnose squamous cell carcinoma of the esophagus: a systematic review and meta-analysis

“…These sensitivities were as follows: Lugol chromoendoscopy per-patient and per-lesion: 92 and 88%, respectively, and NBI per-patient and per-lesion: 98 and 94%, respectively. Most of the published papers came to the same conclusion, except for two [18, 19]. These two included low-grade dysplasia in the true positives, a finding that was regarded as a methodological error in this review and consequently excluded from the meta-analysis.…”

“…Eighteen studies were included in the systematic review, but six were not included in the meta-analysis for the following reasons: Two studies considered low-grade dysplasias to be true positives, and it was not possible to separate and analyze the data from these studies, which consider them to be false positives [18, 19]. Two did not provide complete data to calculate sensitivity, specificity, and accuracy values in either the per-patient or per-lesion analysis [7, 20].…”

Endoscopic screening for synchronous esophageal neoplasia among patients with incident head and neck cancer: Prevalence, risk factors, and outcomes

“…[9][10][11][12][13][14] One explanation for differences in ESCN prevalence or detection rates was the diagnostic modality. [9][10][11][12][13][14] One explanation for differences in ESCN prevalence or detection rates was the diagnostic modality.…”

“…Image-enhanced endoscopy, both dye-based and equipmentbased methods, has been recommended to improve the diagnostic accuracy for esophageal neoplasia in high-risk patients. [9][10][11][12][13][14] Another possible cause was the difference in percentages of index HNSCC locations. 15 Another explanation for the wide difference in incidence was differences in definition of ESCN across studies.…”

“…Wang et al 13 Interestingly, in addition to the digestive (pharynxesophagus) axes, our study and Chung et al 11 also found laryngeal cancer, part of the respiratory (larynx-lung) system, also fitted in the field cancerization theory. 18,24 Although betel quid was not an independent risk factor, it did add to the carcinogenetic effect of smoking and alcohol for the development of laryngeal cancer (aOR5 40.3).…”